Effect of HIV and antiretroviral therapy on semen quality

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Background: Semen is the major vehicle for HIV-1 infection. However, the supposed detrimental effect of HIV on semen quality has been a matter of unsettled debate. Antiretroviral therapy can effectively decrease the levels of viral load in peripheral plasma and seminal fluid of infected men and also relieve the symptoms of the disease, but whether or not it improves semen quality remains unknown currently. Methods: Semen characteristics of 129 subjects made up of 100 HIV-infected men, (25 HIV-infected men with slight symptoms of opportunistic infections, 25 asymptomatic HIV-infected men, 25 HIV-infected men who have been on ART for less than 1 year, 25 HIV-infected men who have been on ART for 1 or more years) and 29 HIV-negative healthy control men capable of reproducing were evaluated. Results: Semen quality was negatively affected in the HIV- infected cohorts. Semen parameters that were negatively affected in the HIV-infected groups (G1, G2, G3 and G4), compared with the HIV-negative control (G5) were: reduced semen volume (P ≤ 0.05), reduced percentages of rapid progressive sperm (P ≤ 0.05), increased immotile spermatozoa percentages (P≤ 0.05), reduced sperm concentration (P≤ 0.05), total sperm count (P≤ 0.05), increased immature germ cells ( P ≤ 0.05), increased RBC count (P≤ 0.05), reduced normal morphology of spermatozoa (P≤ 0.05), reduced percentages of sperm vitality (P≤ 0.05) and increased pH (P≤ 0.05). Within the HIV-infected groups, G2, G3 and G4 exhibited significantly better semen parameters such as rapid progressive motile sperm, slow progressive motile sperm, sperm concentration, total sperm count, immature germ cell loss, haemospermia, normal morphological sperm and sperm vitality compared with G1 at P≤ 0.05. However, only total sperm count, sperm concentration of G5 and sperm concentration of G3 showed significant correlations with absolute CD4+ counts (P ≤ 0.05) Conclusions: HIV infection reduced semen quality of infected men compared with HIV-negative men. Within the HIV-infected men, the asymptomatic HIV-infected men showed better semen quality than the symptomatic ART naïve men. Within the HIV-infected men on ART, longer duration of treatment had relative positive effect on semen quality than shorter duration of treatment.
A thesis submitted to the Department of Physiology, School of Medical Sciences, College of Health Sciences, KNUST, Ghana, for the award of the degree of Mphil in Physiology